Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Abstract

INTRODUCTIONA complex relationship exists between chronic kidney disease-mineral and bone disorder (CKD-MBD) and adverse outcomes among dialysis patients. This study aimed to report the prevalence of CKD-MBD and examine the impact of achieving target CKD-MBD parameters on morbidity and mortality one year after peritoneal dialysis (PD) initiation. METHODSIn this retrospective cohort study, patients electively initiated on PD were followed up for one year. Laboratory parameters were collected and the prevalence of CKD-MBD 4-6 months after PD initiation was determined based on the Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Linear regression and Cox proportional hazards model were used to evaluate the effects of achieving CKD-MBD targets 4-6 months after PD initiation on hospitalisation, the incidence of peritonitis or exit-site infections (ESIs), and mortality at one year. RESULTSThe prevalence of CKD-MBD among the 86 patients in this study was 86.0% (KDOQI) and 54.7% (KDIGO).There was no significant difference in hospitalisation duration between patients who achieved targets and those who did not. Patients who failed to meet all the KDIGO CKD-MBD or calcium serum targets had a higher incidence of peritonitis or ESI. A trend toward shorter time to death was observed among patients who failed to meet the KDIGO phosphorus serum targets.CONCLUSION There was moderate (KDIGO) to high prevalence (KDOQI) of CKD-MBD among the patients. Achievement of all the KDIGO CKD-MBD or calcium serum targets was associated with reduced peritonitis or ESI, while achievement of the KDIGO phosphorus serum targets was associated with improved survival.

Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients

“…CKD-MBD has been reported to be associated with the development of peritoneal calcifications in a PD patient [ 17 ] and the presence and severity of peritoneal calcification are associated with peritonitis [ 18 ]. Chuang et al reported that the failure of serum calcium, phosphorous and intact-PTH concentration to achieve KDIGO’s targets for CKD-MBD was related with incidence of peritonitis or exit-site infections in incident PD patients in their retrospective study [ 12 ]. Therefore, it may be postulated that peritoneal calcification in PD patients with CKD-MBD have higher risk of PD-related peritonitis and consequently serum ALP as a biomarker of CKD-MBD may predict PD-related peritonitis.…”

“…A previous study demonstrated that bone cell differentiation interplays with B cell differentiation, which indicates that bone metabolism may influence the innate immune system [ 10 ]. Furthermore, the previous retrospective studies reported that chronic kidney disease (CKD)-mineral and bone disorders (MBD), an established risk factor for vascular calcification in CKD patients, was reported to be associated with short-term adverse outcomes of PD-related peritonitis in PD patients [ 11 , 12 ].…”

Phosphate Balance and CKD–Mineral Bone Disease

“…Patients with CKD are often affected by CKD-MBD. 1 Characterized by hormone and bone abnormalities, 2 CKD-MBD is known to be associated with increased CV mortality, 3 a significant cause of death in patients on dialysis. 4 Phosphate control is a logical and attractive approach for treatment of CKD-MBD due to both the centrality of phosphate homeostasis in the development and progression of CKD-MBD and the independent association between hyperphosphatemia and CV disease (CVD).…”

Aspectos epidemiológicos de pacientes com doença renal crônica em programa de diálise peritoneal: levantamento de 22 anos

“…Já em comparação com estudos internacionais, estes dados foram corroborados em relação a descrição dos resultados dos estudos. (CHUANG et al, 2016;RAJAEEFARD et al, 2016;SANABRIA et al, 2015).…”

“…Diferentemente, Jin et al (2015) encontrou uma frequência de apenas 30% dos pacientes em uso de EPO, porcentagem bem menor que a encontrada na população deste estudo. (CHUANG et al, 2016; (JIN et al, 2015;MARUYAMA et al, 2015;RAJAEEFARD et al, 2016;TORLE Ń et al, 2012). Já em uma coorte retrospectiva de 10.527 pacientes, os achados demonstram valores superiores aos deste estudo, com média de 12,2g/dL de hemoglobina.…”